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AF | PDBR | CY2014 | PD 2014 00852
Original file (PD 2014 00852.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXX     CASE: PD-2014-00852
BRANCH OF SERVICE: AIR FORCE     BOARD DATE: 20140918
SEPARATION DATE: 20081105


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSgt/E-5 (3P071/Security Forces) medically separated for atypical migraine syndrome. The migraine condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty (AFS) or satisfy physical fitness standards. He was issued a temporary P4 profile and referred for a Medical Evaluation Board (MEB). The migraine condition, characterized as “atypical migraine syndrome,” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123. The Informal PEB adjudicated “atypical migraine syndrome” as unfitting, rated at 10%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION: “Migraine headaches are still very much prevalent. Get them 2-3x per week, and have since my enlistment. Still experiencing floaters in my vision and have gone to the E.R. multiple time for changes in my vision, i.e., temporary vision loss. (VA rated me at 40%, now 70%).” His complete submission is at Exhibit A.


SCOPE OF REVIEW: The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2). It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI. The rating for the unfitting migraine condition is addressed below and no additional conditions are within the DoDI 6040.44 defined purview of the Board. Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.

The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws. The Board considers VA evidence proximate to separation in arriving at its recommendations and DoDI 6040.44 defines a 12 months interval for special consideration to post-separation evidence. Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation.


 RATING COMPARISON :

Service IPEB – Dated 20080922
 VA - (3 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Atypical Migraine Syndrome 8100 10% Migraine Syndrome….. 8100 30% 20090206
Other x 0 (Not in Scope)
 Other x 2 20090206
Rating: 10%
 Combined: 40%
Derived from VA Rating Decision (VA RD ) dated 200 90305 (most proximate to date of separation )
ANALYSIS SUMMARY:

Atypical Migraine Syndrome Condition. Review of the service treatment record (STR) showed that the CI developed headaches after repair of a retinal detachment in 2005. In August 2007, he was noted to experience “chronic, everyday…minor headache” that was not severe. A neuro-ophthalmology follow-up evaluation in December 2007 (11 months prior to separation) determined that the subjective appearance of a “black, pulsating spot” in his left eye followed by a severe throbbing headache represented an unusual (“atypical”) migraine syndrome. It was noted that a sense of depression for several hours prior to onset of headache was part of the prodromal state. Neuro-ophthalmology follow-up dated 5 February 2008 (9 months prior to separation) concluded that some daily headache symptoms were due to over-consumption of over-the-counter analgesics and that the migraine syndrome appeared to be “of low-grade intensity and frequency.” Re-evaluation on 1 August 2008 reported that since taking a daily medication for headache prophylaxis and decreasing OTC medication and coffee, headaches were less frequent and intense.

The narrative summary (NARSUM) dated 28 April 2008 (6 months prior to separation) noted a chief complaint of “black spots in vision after running” that lasted for 30 minutes. The spot was distracting during prolonged driving. He denied problems with day to day activities or performing duties. He reported having headaches 3 times per week, which were relieved with over the counter (OTC) medication. In his letter to the PEB dated 19 May 2008, the CI wrote that he had not missed any work time due to his medical condition.

The commander’s statement on 20 May 2008 confirmed this statement. Although he was unable to drive at night and experienced difficulty focusing on objects due to spots in his vision, he continued “to perform all of his primary in-garrison military duties without restrictions, minimal limitations or work-a-rounds.” A follow-up note on 4 August 2008 (3 months prior to separation) indicated the CI’s condition was “stable on treatment.” The final STR note in evidence dated 7 October 2008 reported that the CI was pain free and denied “any health concerns.”

At the VA Compensation and Pension (C&P) exam performed 3 months post-separation, the CI reported having headaches 2 to 3 times per month. He indicated that response to medication was “good” and that headaches usually lasted for hours. Although it was stated that “less than half of the attacks are prostrating,” there was no effect on usual daily activities.

The Board directed attention to its rating recommendation based on the above evidence. The PEB assigned a 10% rating, indicating the evidence of record showed that prostrating attacks averaged one in two months over the previous several months. The VA rated the condition at 30% for prostrating attacks occurring an average of once per month. When rating headaches under the diagnostic code 8100 (migraine headaches), VA guidance uses the clear English definition of prostrating. The standard dictionary definition of “prostration” is “utter physical exhaustion or helplessness.” In deliberating the frequency of prostrating attacks leading up to the time of separation, the Board noted that there were no missed duty days according to the commander’s statement; there were no problems performing daily activities per the NARSUM and VA C&P examiners and headaches were relieved with over the counter medication. The Board agreed that the described clinical picture most closely approximated the 10% criteria. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the atypical migraine syndrome condition.


BOARD FINDINGS: IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication. The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised. In the matter of the atypical migraine syndrome condition and IAW VASRD §4.124a, the Board unanimously recommends no change in the PEB adjudication. There were no other conditions within the Board’s scope of review for consideration.


RECOMMENDATION: The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20140220, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record






                          
         XXXXXXXXXXXXXX
         President
         Physical Disability Board of Review
SAF/MRB
Dear XXXXXXXXXXXXXX:

         Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2014-00852

         After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate. Accordingly, the Board recommended no re-characterization or modification of your separation.

         I have carefully reviewed the evidence of record and the recommendation of the Board. I concur with that finding and their conclusion that re-characterization of your separation is not warranted. Accordingly, I accept their recommendation that your application be denied.

                                                               Sincerely,






 XXXXXXXXXXXXXX
Director
Air Force Review Boards Agency
Attachment:
Record of Proceedings

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